Abstract
The brain has a large capacity for automatic simultaneous processing and integration of sensory information. Combining information from different sensory modalities facilitates our ability to detect, discriminate, and recognize sensory stimuli, and learning is often optimal in a multisensory environment. Currently used multisensory stimulation methods in stroke rehabilitation include motor imagery, action observation, training with a mirror or in a virtual environment, and various kinds of music therapy. Non-invasive brain stimulation has showed promising preliminary results in aphasia and neglect. Patient heterogeneity and the interaction of age, gender, genes, and environment are discussed. Randomized controlled longitudinal trials starting earlier post-stroke are needed. The advance in brain network science and neuroimaging enabling longitudinal studies of structural and functional networks are likely to have an important impact on patient selection for specific interventions in future stroke rehabilitation. It is proposed that we should pay more attention to age, gender, and laterality in clinical studies.
Highlights
We live in a multisensory environment and the interaction between our genes and the environment shapes our brains
Repetitive transcranial magnetic stimulation cannot directly target subcortical structures, the activity in thalamus can be modulated by stimulation of parietal cortex, an observation that open up new possibilities for studies of cortical– subcortical interactions in multisensory processing (Blankenburg et al, 2008, 2010)
The improvement did not persist at follow-up, but fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only (p < 0.05)
Summary
We live in a multisensory environment and the interaction between our genes and the environment shapes our brains. Brain imaging studies suggest that areas responding to the observation and performance of actions are more widespread in the human brain and that multiple regions that process both sensory and motor information have the potential to contribute to mirror effects.
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